After two decades of costly new surgical procedures involving open heart surgery and multiple types of replacement therapies, the editor of this volume writes, "surgeons must become actively involved in research on surgical health care services." Rutkow has assembled a group of public health planners to discuss issues of ethics, morality, cost-effectiveness, and cost benefits of surgery in a decade of limited health care dollars.

Dr Rutkow has tackled the issue of a higher rate of surgery in the United States. Is such a high rate a consequence of fee for service, in contrast to the prepaid group practice of health maintenance organizations or to nations with nationalized health care programs? Do prepaid group practices and HMOs encourage less than optimal care by denying or delaying elective surgery? Have the surgical second-opinion programs been cost-effective while promoting higher-quality surgical care? What constitutes the "unnecessary surgical procedure"? The authors have addressed